Chao Tiffany N, Kuan Edward C, Tong Charles C L, Kohanski Michael A, Grady M Sean, Palmer James N, Adappa Nithin D, O'Malley Bert W
Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, United States.
Department of Otolaryngology, Head and Neck Surgery, University of California-Irvine, Irvine, California, United States.
J Neurol Surg B Skull Base. 2021 Jul;82(Suppl 3):e148-e154. doi: 10.1055/s-0040-1701219. Epub 2020 Feb 7.
Surgical resection is widely accepted as a critical component for definitive treatment of sinonasal mucosal melanoma. Systemic immunotherapy, including multiple newer agents, has been used to treat metastatic or unresectable disease. In this study, we examine its efficacy in locoregional control when used in conjunction with surgical resection for primary mucosal lesions. Present study is a retrospective review of all patients at a tertiary academic medical center with primary sinonasal mucosal melanoma and distant metastatic disease. A total of four patients were identified. In all cases, patients were treated with a combination of surgical resection of the primary tumor and systemic immunotherapy. Three patients were initially treated with surgery at the primary site followed by immunotherapy for distant metastases. Response to immunotherapy at the sites of primary and metastatic disease was seen in two patients. All four patients developed progression or recurrence at the primary site following initiation of immunotherapy for which they underwent surgical resection. One patient remains in follow-up without evidence of disease 20 months after initial treatment; three succumbed to the disease at 135, 37, and 16 months after initial treatment. Surgical resection for local control plays a critically important role in the treatment of sinonasal mucosal melanoma regardless of the presence of metastases and whether immunotherapy will be given. This case series suggests that, though immunotherapy may demonstrate efficacy in managing distant disease, surgery should remain the first-line treatment for the primary site.
手术切除被广泛认为是鼻窦黏膜黑色素瘤确定性治疗的关键组成部分。全身免疫疗法，包括多种新型药物，已被用于治疗转移性或不可切除的疾病。在本研究中，我们研究了其与原发性黏膜病变手术切除联合使用时在局部区域控制方面的疗效。
本研究是对一家三级学术医疗中心所有患有原发性鼻窦黏膜黑色素瘤和远处转移性疾病的患者进行的回顾性研究。
共确定了4例患者。在所有病例中，患者均接受了原发性肿瘤手术切除和全身免疫疗法的联合治疗。3例患者最初在原发部位接受手术，随后针对远处转移进行免疫治疗。2例患者在原发性和转移性疾病部位对免疫治疗有反应。所有4例患者在开始免疫治疗后原发部位均出现进展或复发，为此他们接受了手术切除。1例患者在初始治疗20个月后仍在随访中，无疾病证据；3例患者在初始治疗后135、37和16个月死于该疾病。
无论是否存在转移以及是否给予免疫治疗，手术切除以实现局部控制在鼻窦黏膜黑色素瘤的治疗中都起着至关重要的作用。该病例系列表明，尽管免疫疗法在管理远处疾病方面可能显示出疗效，但手术仍应作为原发部位的一线治疗方法。
